Assessment of human resources for health
SAMPLE QUESTIONNAIRE FOR HEALTH CARE PROVIDERS
IDENTIFICATION
Name of the health facility:
Type of facility:
Hospital
Health centre
Health clinic
Office
Mobile clinic
Pharmacy
Other (specify): ___________________
Name of district/town:
Facility code:
1
2
3
4
5
6
8
Facility operated by:
Government
Private, for-profit entity
Nongovernment organization (NGO)
Charitable organization
Religious organization
District/town code:
Name of province/state:
Province/state code:
Name and code of field investigator:
Urban/rural:
Capital city
Other urban
Rural
Date of interview:
Day
Result of final interview:
Completed
Partially completed
Refused
Respondent not found
Name and code of respondent:
1
2
3
4
5
1
2
3
4
1
2
3
Month
Year
2002
Occupation of respondent:
Doctor
Nurse
Midwife
Auxiliary nurse
Auxiliary midwife
Pharmacist
Physiotherapist
Other health professional
1
2
3
4
5
6
7
8
READ TO RESPONDENT:
You have been randomly selected to be part of a survey on health and human resources, and this is why we would
like to interview you. This survey is conducted by the World Health Organization and is being carried out by
professional interviewers from (name of institution). The survey is currently taking place in several countries around
the world.
The interview will take approximately 15 minutes. I will ask you some questions about your work as a health care
provider, including the practices and experiences at this and other facilities where you work. The information you
provide will be used only to understand about the types of activities, payments and general working conditions of
health workers in different countries.
The information you provide is totally confidential and will not be disclosed to anyone. It will be used only for
research purposes. Your name, and the name and location of this facility, will be removed from the questionnaire,
and only a code will be used to connect your answers with the facility without identifying you.
Your participation is voluntary and you are free to refuse to answer any question in the questionnaire. If you have
any questions about this survey you may ask me or contact (name of institution and contact details).
Are you willing to participate in this survey?
Agreed [ ]
Refused [ ]
Section 1. Work status, conditions and qualifications
N°
101
Question
I would like to ask you some questions about your work as a health
care provider and practices at this facility.
How would you best describe your occupation at this facility?
102
103
What was the highest level of schooling you reached to become a
practising health care provider?
Response code
Medical doctor ................................................. 1
Dentist ............................................................. 2
Pharmacist ....................................................... 3
Nurse................................................................ 4
Midwife............................................................. 5
Optometrist or optician .................................... 6
Physiotherapist ................................................ 7
Medical assistant ............................................. 8
Dental assistant ............................................... 9
Pharmaceutical assistant .............................. 10
Nursing associate or auxiliary ....................... 11
Midwife associate or auxiliary........................ 12
Traditional/faith healer................................... 13
Other (specify)_______________________ 14
Diploma............................................................ 1
Associate degree ............................................ 2
Baccalaureate degree ..................................... 3
Master’s degree ............................................... 4
Doctorate ......................................................... 5
Other health degree (specify)____________ 6
Other non-health (specify)____________ ...... 8
No formal degree............................................. 9
Skip to
º106
º106
In what year did you reach this level?
Year
104
In what country did you reach this level?
105
In which school did you reach this level?
106
a) How many hours a week do you usually work at this facility,
excluding unpaid mealtimes and on-call hours?
(On-call hours are those, such as during nights and weekends,
when you must be available for duty but do not have to be
physically present on the hospital ward or in a clinic or laboratory
except when patient needs require it.)
Country of work location .................................. 1
Other country (specify)_________________ . 2
Name of school:
º106
Hours. . . .
b) Did you work on-call hours at this facility in the last 30 days?
Hours. . . .
IF YES: How many on-call hours did you work here in the last 30
days?
107
What type of work do you usually do at this facility for pay?
(CIRCLE ALL THAT APPLY)
None ................................................................ 0
Direct patient care............................................ 1
Consultation with agencies/professionals...... 2
Administration/supervision .............................. 3
Teaching .......................................................... 4
Research.......................................................... 5
Laboratory/diagnostic procedures................... 6
Dispensing ....................................................... 7
Other (specify)_______________________ .. 8
Other (specify)_______________________ .. 9
Not worked for pay_____________________10
º109
º109
º109
º109
º109
º109
º109
º109
º114
Number. . . .
108
How many patients have you personally seen here in the last 30
days?
109
How would you describe the method by which you are usually paid at Salary ............................................................... 1
this facility?
Fee-for-service only......................................... 2
Capitation (fixed per patient) .......................... 3
Capitation plus fees for extra services ............ 4
Other (specify)_______________________ .. 8
Dispensed medicines ...................................... 1
For which types of services do you usually receive extra fees?
Other medical supplies/consumables ............ 2
Immunizations.................................................. 3
(CIRCLE ALL THAT APPLY)
Laboratory/diagnostic procedures................... 4
Other (specify)_______________________ .. 8
Other (specify)_______________________ .. 9
Do not know ............................................... 9998
110
Assessment of human resources for health: health care providers questionnaire
º111
º111
º111
º111
2
111
We are interested in knowing the average income of health workers
Per week
and people trained in the health field. Such information is of value
when discussing health care financing options for your country.
Remember that whatever you say is confidential and will be used only Per month
for research purposes.
Per year
Thinking over the past year, can you tell me what your average
earnings from working at this facility have been? Please tell me the
amount per week or per month or per year, whichever is easiest for
Refuse ..................................................... 9998
you.
Don't know .............................................. 9999
112
In the past 12 months, have you experienced a delay in receiving
your pay as scheduled from your employer?
113
Yes ................................................................... 1
No.................................................................... 2
Not applicable .................................................. 3
º114
º114
How long would you say the delays have lasted, on average?
Number of days
(RECORD IN DAYS, WEEKS OR MONTHS AS ANSWERED)
Number of weeks
Number of months
114
115
116
Do you receive any of the following additional benefits from working
here:
YES NO
Allowance for meals……………………….1
2
Allowance for housing……………………. 1
2
2
(READ EACH TYPE OF BENEFIT AND RECORD ALL ANSWERS) Allowance for transportation…….………..1
Paid vacations…………………..………….1
2
Health care insurance/medical expenses.1
2
Do you regularly receive any in-kind payments from patients, or extra Yes ................................................................... 1
payments for making referrals or from other sources?
No.................................................................... 2
Are you currently certified to practise as a health care provider by any Yes ................................................................... 1
National Certifying Body?
No.................................................................... 2
117
Which certifying body?
Name of body:
118
Are you currently a member of any professional association(s)?
119
Which association(s)?
Yes ................................................................... 1
No.................................................................... 2
Name of association(s):
120
In the past 12 months, have you been in any health/medical
professional training or continuing education programmes?
Yes ................................................................... 1
No..................................................................... 2
121
For how many days (in the last 12 months) have you been on such
programmes?
Number of days . . .
122
Do you have the right to strike?
123
Have you gone on a labour strike at any time in the last 12 months,
even for a short period?
IF YES: For how many days (in the last 12 months) did you go on
strike?
Yes ................................................................... 1
No.................................................................... 2
Don’t know ....................................................... 3
º118
º120
º201
º201
º201
Days. . . .
None ................................................................ 0
Assessment of human resources for health: health care providers questionnaire
3
Section 2. Secondary employment
N°
201
Question
Response code
Now I would like to ask you some questions about your work activities Yes ................................................................... 1
at other locations.
No.................................................................... 2
Skip to
º301
In addition to your work at this facility, have you worked at another
location in the last 30 days?
202
How would you best describe this other place where you worked?
203
a) How many hours a week do you usually work at this other location,
excluding unpaid mealtimes and on-call hours?
Government hospital ....................................... 1
Government health centre .............................. 2
Government health post .................................. 3
Government mobile clinic ................................ 4
Other public health facility (specify) ________5
Private/NGO hospital ....................................... 6
Private/NGO health clinic ................................ 7
Private/NGO mobile clinic................................ 8
Private office .................................................... 9
Other private health facility (specify) ______10
Pharmacy....................................................... 11
Other non-health (specify)____________ .... 12
Hours. . . .
b) Did you work on-call hours at this other location in the last 30 days? Hours. . . .
204
IF YES: How many on-call hours did you work there in the last 30
days?
What type of work do you usually do at this other location for pay?
(CIRCLE ALL THAT APPLY)
205
How would you describe the method by which you are usually paid at
this other location?
206
For which types of services do you usually receive extra fees there?
(CIRCLE ALL THAT APPLY)
207
None ................................................................ 0
Direct patient care............................................ 1
Consultation with agencies/professionals...... 2
Administration/supervision .............................. 3
Teaching .......................................................... 4
Research.......................................................... 5
Laboratory/Diagnostic procedures .................. 6
Dispensing ....................................................... 7
Other (specify)_______________________ .. 8
Other (specify)_______________________ .. 9
Not worked for pay_____________________10
Salary ............................................................... 1
Fee-for-service only......................................... 2
Capitation (fixed per patient) .......................... 3
Capitation plus fees for extra services ............ 4
Other (specify)_______________________ .. 8
Dispensed medicines ...................................... 1
Other medical supplies/consumables ............ 2
Immunisations.................................................. 3
Laboratory/Diagnostic procedures .................. 4
Other (specify)_______________________ .. 8
Other (specify)_______________________ .. 9
º208
º207
º207
º207
º207
What are your average earnings from working at this second location?
Please tell me the amount per week or per month or per year,
Per week
whichever is easiest for you. (Remember that whatever you say is
confidential and will be used only for research purposes.)
Per month
Per year
Refuse .....................................................9998
Don't know ..............................................9999
208
Do you receive any of the following additional benefits from working
there?
(READ EACH TYPE OF BENEFIT AND RECORD ALL ANSWERS)
Assessment of human resources for health: health care providers questionnaire
YES NO
Allowance for meals……………………….1
2
Allowance for housing……………………. 1
2
Allowance for transportation…….………..1
2
Paid vacations…………………..………….1
2
Health care insurance/medical expenses.1
2
4
Section 3. Occupational mobility
N°
301
Question
I would like to ask a few questions about your work experience.
302
How many years of experience do you have in practice as a health care
provider?
For how long have you been working at this facility here?
Response code
Skip to
Years. . . .
Number of weeks
(RECORD IN WEEKS, MONTHS OR YEARS AS ANSWERED)
303
How would you describe the last place where you worked before
coming to this facility?
304
What type of work did you usually do at that last location for pay?
(CIRCLE ALL THAT APPLY)
305
Where was your former work located?
Number of months
Number of years
Government hospital ....................................... 1
Government health centre.............................. 2
Government health post .................................. 3
Government mobile clinic ................................ 4
Other public health (specify) _____________ 5
Private/NGO hospital....................................... 6
Private/NGO health clinic ................................ 7
Private/NGO mobile clinic ............................... 8
Private office .................................................... 9
Other private health (specify) ___________10
Pharmacy....................................................... 11
Other non-health (specify)______________ 12
Same as current secondary place................. 13
Direct patient care............................................ 1
Consultation with agencies/professionals...... 2
Administration/supervision .............................. 3
Teaching .......................................................... 4
Research.......................................................... 5
Laboratory/diagnostic procedures................... 6
Dispensing ....................................................... 7
Other (specify)_______________________ .. 8
Other (specify)_______________________ .. 9
Not applicable/Was not paid ......................... 10
In the same city/rural district............................ 1
In a different city ............................................. 2
In a different rural district................................. 3
In another country (specify)______________ 4
If less than
one month,
or same as
total years
experience
º401
º401
Section 4. Sociodemographic characteristics
N°
401
402
Question
Lastly, some additional information for use in the statistical
interpretation of your responses:
Response code
Male ................................................................. 1
Female ............................................................ 2
Skip to
RECORD SEX AS OBSERVED
What is your date of birth?
Month
Year
Contacts at World Health Organization Headquarters, Geneva, Switzerland
Dr Alexandre Goubarev: Fax: +41 22 791 4747; Email: goubareva@who.int
Dr Mario Dal Poz: Fax: +41 22 791 4747; Email: dalpozm@who.int
Assessment of human resources for health: health care providers questionnaire
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